Aripiprazole (Abilify)

HALF-LIFE: Aripiprazole 74 hours; Active metabolite 94 hours
STARTING DOSE: 2mg-15mg daily
TARGET DOSING RANGE: 2mg-30mg PO daily
BEST TIME TO DOSE: Any
HOW TO DOSE:
>> Schizophrenia and mania: Initial 10mg-15mg PO daily
Max dose 30mg PO daily
>> Adjunct for depression: Initial 2mg-5mg PO daily. Increase
dose by 5mg per day at intervals of >1 week
Max dose 15mg PO daily
>> Autism and Tourette's disorder: Initial 2mg PO daily. Increase
dose by 5mg/day at intervals of >1 week
Max dose 10mg-15mg PO daily
PREGNANCY: Minimal data on safety
BREASTFEEDING: Minimal data on safety
FDA INDICATIONS:
1) Schizophrenia, 13yo and older
2) Acute mania/mixed episodes, 10yo and older
3) Bipolar maintenance
4) Adjunct for Unipolar depression
5) Autism-related irritability, 6-17yo
6) Tourette's disorder, 6-18yo
7) Acute agitation associated with schizophrenia or bipolar disorder (IM)

ADDITIONAL INFORMATION

  • Partial agonist at D2 receptor
  • 5HT2A affinity less than D2 affinity
  • 5HT1A partial agonist actions more potent than 5HT2A antagonist actions
  • Usually not sedating (lacks M1 and H1 antagonism)
  • Minimal weight gain, rare dyslipidemia, rare insulin resistance (except in some children and adolescents)
  • Minimal to no QTc prolongation
  • Antidepressant actions partially explained by 5HT1A partial agonism and 5HT7 antagonism
  • Akathisia common
  • Lower doses may be more activating than higher doses
  • Monitor for compulsive behaviors (such as gambling) with Abilify
  • Metabolized by CYP2D6 and CYP3A4
  • Long acting depot formulations available

References:

  1. Cooper, J. R., Bloom, F. E., & Roth, R. H. (2003). The biochemical basis of neuropharmacology (8th ed.). New York, NY, US: Oxford University Press.
  2. Iversen, L. L., Iversen, S. D., Bloom, F. E., & Roth, R. H. (2009). Introduction to neuropsychopharmacology. Oxford: Oxford University Press.
  3. Puzantian, T., & Carlat, D. J. (2016). Medication fact book: for psychiatric practice. Newburyport, MA: Carlat Publishing, LLC.
  4. J. Ferrando, J. L. Levenson, & J. A. Owen (Eds.), Clinical manual of psychopharmacology in the medically ill(pp. 3-38). Arlington, VA, US: American Psychiatric Publishing, Inc.
  5. Schatzberg, A. F., & DeBattista, C. (2015). Manual of clinical psychopharmacology. Washington, DC: American Psychiatric Publishing.
  6. Schatzberg, A. F., & Nemeroff, C. B. (2017). The American Psychiatric Association Publishing textbook of psychopharmacology. Arlington, VA: American Psychiatric Association Publishing.
  7. Stahl, S. M. (2014). Stahl’s essential psychopharmacology: Prescriber’s guide (5th ed.). New York, NY, US: Cambridge University Press.
  8. Stahl, S. M. (2013). Stahl’s essential psychopharmacology: Neuroscientific basis and practical applications (4th ed.). New York, NY, US: Cambridge University Press.
  9. Whalen, K., Finkel, R., & Panavelil, T. A. (2015). Lippincotts illustrated reviews: pharmacology. Philadelphia, PA: Wolters Kluwer.

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